Using Payment by Results to commission better quality clinical care
Eileen RobertsonPayment by Results (PbR) Development Team
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Outline
What is Payment by Results?
Using PbR to commission better quality care
Supporting best practice: Fragility hip fractures
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What is Payment by Results?
The aim of PbR is to provide a transparent rules-based system for paying providers in England
a system in which PCTs pay hospitals for the number and complexity of patients treated, using a price list – the national tariff – for all activity within the scope of PbR
covers admitted patients, outpatients and A&E
new way of funding NHS activity introduced in 2003-04
replaced block contracts based on historic costs
part of a group of payment systems known internationally as casemix funding
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At a basic level the tariff is…
Tariff
A fixed price
Priced at national average cost
Paid per patient
At spell levelPer HRG
Published annually
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Using PbR to commission better quality care
PbR focuses negotiations between commissioners and providers away from price and towards quality
Introduction of best practice tariff to better support improved quality
Is better quality clinical care more efficient? Reduce length of stay
Reduce re-admissions
Improved outcomes
Wider health and social care impact
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Supporting better quality care: Fragility Hip Fracture
High Quality Care for All (HQCFA) report
High volume service area
Significant variation in clinical practice
Improve both quality and value
Excellent source of clinical data (NHFD)
Support existing work on fragility hip fracture care
From April 2010 PbR will be introducing a “Best Practice Tariff” for fragility hip fractures.
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The best practice tariff aims to…
Reduce unexplained variation in quality and universalise best practice.
Characteristics are best practice – they go beyond the standard
Key clinical characteristics:
Surgery within 36
hours
Involvement of an (ortho)-geriatrician
AND
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Definition of characteristics
1. Time to surgery Arrival in A&E or diagnosis if an inpatient to start of anaesthesia
2. Involvement of an (ortho)-geriatrician: All 4 required
a) Admitted under the joint care of a Consultant Geriatrician and a Consultant Orthopaedic Surgeon
b) Admitted using an assessment protocol agreed by geriatric medicine, orthopaedic surgery and anaesthesia
c) Assessed by a Geriatrician * in the perioperative period **
* Geriatrician defined as Consultant, NCCG, or ST3+
** Perioperative period defined as within 72 hours of admission
d) Postoperative Geriatrician-directed:
Multiprofessional rehabilitation team
Fracture prevention assessments (falls and bone health)
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Best practice care costs less…
“Looking after hip fracture patients well is a lot cheaper than looking after them badly.”
The ‘Blue Book’ (p. 10)
invest
save
time
unit cost
Cost profile of meeting best practice
Tariff to reflect this
profile over time
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The tariff will be paid in two-parts…
Reduction in base tariff for national compliance rate
Additional payment for best practice
Base tariff for each HRG
Payment per
patient
National average
cost
National Hip Fracture Database captures compliance with clinical practice
PCTs to monitor and make additional payments quarterly
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Summary of best practice tariff
Aim is to universalise best practice around two key characteristics with hip fracture care
Payment to be a 2-part tariff with compliance to be monitored through NHFD
Additional funding to providers of best practice care
PCTs reap financial benefits through savings in super-spell and future reductions in tariff
2010/11 is an opportunity to change practice